PROSPECTUS

for
POST GRADUATE DENTAL COURSES

(FOR ADMISSION TO MASTER Of DENTAL SURGERY (MDS)

COURSE SESSION 2019-20)

PANJAB UNIVERSITY
DR. HARVANSH SINGH JUDGE INSTITUTE OF DENTAL SCIENCES
AND HOSPITAL, CHANDIGARH

Website: http://dentalsciences.puchd.ac.in

1
PANJAB UNIVERSITY ANTHEM

2
 MESSAGE

Dr. Harvansh Singh Judge Institute of Dental Sciences

offers a stairway to aspirations and hopes in the field of Oral
Health Sciences. This budding Institution, established in the
year 2006 has labs and clinics, equipped with latest
advancements. It is a frontrunner amongst the premier Dental
Prof. Raj Kumar Institutes in the country. Availability of Hi Tech
Vice Chancellor infrastructure, experienced faculty, support of Panjab
University departments and research collaboration with
premier institutes like PGI, GMCH-32, CSIR-IMTech are
some of its strengths. The Alumni of this Institute have
secured positions in eminent institutes like AIIMS, PGI, Tata
Institute of Social Sciences. They are employed in the
Administrative Services, Government jobs and Foreign
Universities.

The Institute has devised its curriculum according to

cutting-edge technology to cater to the oral health needs of
people of very stratum. Education is a lifelong process and it is
important to assimilate knowledge and put it into practice.
We believe in this philosophy and have taken steps in that
direction to provide quality education for the holistic
development of the student. I am sure that as a student; you
will learn, grow and cherish your stay here.

I extend a warm welcome and best wishes to all the

young dentists seeking evolution at the Dr. Harvansh Singh
Judge Institute of Dental Sciences and Hospital.

(Raj Kumar)

3
 MESSAGE

I deem it my privilege to welcome you all to Dr Harvansh

Singh Judge Institute of Dental Sciences & Hospital, Panjab
University, Chandigarh. I am honoured to be associated with
this prestigious Institute that is a part of one of the oldest
Universities in the Country. The institute is ranked amongst
Prof. Jagat Bhushan one of the top Institute.
Principal-cum-Professor Located in the City Beautiful, our Institute caters to the
people of the tri-City and neighbouring areas providing
would class yet affordable patient care to all strata of the
society. The institute offers a 5 year BDS course with 100
admissions per batch and MDS program in 6 specialities
with 17 seats. Our faculty members and dedicated in holding
high the mantle of the Institute. We have an integrated
learning program where the students acquire the desired
skills and knowledge needed. We envisage to mould our
students to be self-confident so that when they enter the
world, they can face all challenges in life with conviction and
success.
There is active and ongoing research carried out in the
Institute by its faculty and post graduate students that are
funded by various agencies such as ICMR, UGC, DST etc. We
also conduct out reach programs to create oral health
awareness to benefits the masses. Out Institute works in
collaborations with various departments of the Panjab
University as well as Institutes like PGIMER, GMCH-32 , CSIR-
IMTech.
I wish you the best in the process of your becoming a part
of this family and wish that you achieve excellence and serve
the society with dedication..

(Jagat Bhushan)

4
 Availability of Prospectus cum Admission Form

 Prospectus cum Admission Form is available on the Website of

Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab
University, Chandigarh i.e. http://dentalsciences.puchd.ac.in/ for
viewing/downloading.

 Copy of the Prospectus can also be obtained from the Dental Institute.

 Only those candidates who submit complete Admission Form along with
specified annexure and fee by due date will be included in the list of
candidates eligible to appear for counseling, subject to fulfillment of other
eligibility criteria, specified in the Prospectus. Candidates are advised to
keep a copy of the submitted Admission Form for their reference.

PROSPECTUS AND ADMISSION FEE

Rs.1500/-(General Category) Rs. 750/- (SC/ST/PwD Category)

ADMISSION FEE MODE:

Demand Draft in favour of “REGISTRAR, PANJAB UNIVERSITY,

CHANDIGARH” payable at Chandigarh. No other mode of fee shall be

accepted.

FACULTY MEMBERS ARE AVAILABLE FOR CONSULTATION AND GUIDANCE

OF THE STUDENTS FROM 3.00 P.M. TO 4.00 P.M. ON WORKING DAYS
(MONDAY TO FRIDAY)

5
 CONTENTS

S. NO. DESCRIPTION PAGE

1. About Panjab University 7
2. About the Institute 8
3. Administration of the Institute 9
4. Admission schedule 10
5. Distribution of MDS Seats 11
6. Eligibility Criteria 12-13
7. General Instructions 14
8. Instructions for counseling and 15-16
interchangeability of seats
9. Check List 17
10. Admission 18
11. Rules for refund of tuition fee 19
12. Anti-Ragging 20
13. Admission Form 21-24
14. Specimen of Character Certificate 25
(Annexure-I)
15. Specimen of Scheduled Caste/Scheduled 26
Tribe Certificate (Annexure-II)
16. Specimen of Backward Class (BC) 27-28
Certificate (Annexure-III & IIIA)
17. Specimen of Medical Examination Forms 29-31
(Annexure-IV)
18. Specimen of Person with Disability (PwD) 32-35
Certificate

6
 PANJAB UNIVERSITY, CHANDIGARH

Since its inception 137 years ago in 1882 (at Lahore, now in Pakistan),
Panjab University, Chandigarh, fourth oldest university in the country, has
been in the forefront in imparting quality education and undertaking
intellectually challenging as well as socially relevant research. By virtue of
its achievements, philosophy and experience, it has become a university of
national recognition and global stature. In the ranking analyses carried out
by different agencies, PU was ranked 1st among Universities of India and
38th in Asia, Times Higher Education Asian University rankings (2015),
13th in BRICS (2014), among top 250 in World University Ranking (2013)
and 2nd in the top 30 institutes from India (2012). The Panjab University
has been ranked 10th in country Times Higher Education Asia University
Ranking 2018. The Chandigarh campus has 85 teaching and research
departments/institutes including 4 independent Chairs and 4 Regional
Centres at Hoshiarpur, Muktsar, Kauni and Ludhiana and 6 constituent
Institutes in rural areas as well as 192 affiliated colleges in Chandigarh and
Punjab State, having a student base of more than 3.5 lacs. For more
information visit Panjab University website: “http://www.puchd.ac.in”.

7
 ABOUT THE INSTITUTE

In view of the imminent need for providing a public funded quality oral
health care set up and to impart dental education and open avenues for
research in the field of oral health, Dr Harvansh Singh Judge Institute of Dental
Sciences was established in April 2006 under the aegis of Panjab University.
The Institute aims at providing oral health care facilities to the general public
and training to the students at both undergraduate and postgraduate levels. It
has the ability to generate ample research avenues in dental/medical sciences
which can have a far reaching affect on oral as well as general health. The
Institute imparts special thrust on community healthcare and outreach
programs for the children and under-served population.

Within this short span the institute has been attending to more than 450
patients everyday in the various specialty clinics. A fully equipped diagnostic lab
is functional at the institute which is carrying out most of bio-chemical,
histopathological and microbiological tests at the institute itself. The institute is
offering BDS course with annual intake of 100 students and MDS course in six
specialties namely Conservative Dentistry, Oral Surgery, Orthodontics,
Periodontics, Prosthodontics and Oral Pathology.

The Institute faculty members are involved in various clinical and basic
sciences research projects. The major focus area of the institution is to provide
good and affordable dental treatment in various specialties to the general
public, carry out clinical and basic research including surveys, diagnostic and
randomized controlled clinical trials, conduct outreach program to enhance oral
health awareness to the population for the benefit of the masses and to provide
clinical and didactic training as part of teaching curriculum.

The institute is already working in collaboration with many institutes like

PGIMER, GMCH-32, CSIR–IMT etc. The dental institute has been ranked
Number One institute in the region consecutively for three years (2012-2014) by
a leading daily newspaper ‘The Tribune’.

The dental Institute has been granted research funding by government

agencies like DST, UGC, SERB, ICMR, IUSSTF and by industry as well e.g.
Waterpik. The publication profile of the dental institute is amongst the best in
the country amongst the dental institutes with publications in high impact
factor journals like Journal of Immunology, Cytokine, and Circulation etc.

Dental Institute is participating in cutting edge technology research by

being a spoke to Design Innovation Centre (DIC), a project granted by UGC.

8
 ADMINISTRATION OF THE INSTITUTE

Name & Designation Telephone (Office)

1. Dr. Jagat Bhushan, Principal-cum-Professor, 0172-2724813,

Dr. Harvansh Singh Judge Institute of Dental 2534686
Sciences, Panjab University
Sector 25, Chandigarh

2. Deputy Registrar 0172-2534688

3. Office Superintendent (Office) 0172-2534687

4. Office Superintendent (Student Section) 0172-2534689

90410-64858 (during
office hours only)

9
 ADMISSION SCHEDULE

1. Date of availability of Prospectus on 23.03.2019 (Saturday)

Institute website
http://dentalsciences.puchd.ac.in/
2. Last date for receipt of complete Admission 05.04.2019 (Friday)
Form alongwith annexures in the office of Till 04.00 pm
Principal-cum-Professor
3. Date of Display of Merit List of eligible 09.04.2019 (Tuesday)
candidates on the Institute website/ Notice By 04.00 pm
Board of the Institute
4. Date of 1st counseling 11.04.2019 (Thursday)
(Venue: LT-1, Ground Floor of the at 11.00 am
Institute)
5. Last date of joining the allotted seat after 1st 18.04.2019 (Thursday)
counseling
6. Commencement of Academic Session 01.05.2019 (Wednesday)
7. Date of 2nd counseling 13.05.2019 (Monday)
(Venue: LT-1, Ground Floor of the at 11.00 am
Institute)
8. Last date of joining the allotted seat after 2nd 20.05.2019
counseling (Monday)
9. Counseling for leftover seats 29.05.2019 (Wednesday)
10. Last date upto which students can be 31.05.2019 (Friday)
admitted/ join against vacancies arising due Till 04.00 pm
to any reason

Website: http://dentalsciences.puchd.ac.in

10
 DISTRIBUTION OF MDS SEATS

Subject Total Seats in General S.C. S.T. B.C. PwD

each Speciality

Conservative 3 2 1
Dentistry &
Endodontics
Oral and 2 1 1
Maxillofacial
Surgery
Orthodontics & 3 2 1
Dentofacial
Orthopedics
Periodontics 3 2 1

Prosthodontics 3 2 1
and Crown &
Bridge
Oral Pathology 3 2 1

Total 17 11 3 1 1 1

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 ELIGIBILITY CRITERIA

1. The admission to MDS course shall be open to candidates who have qualified NEET-
MDS 2019 and are eligible as per eligibility criteria for NEET-MDS 2019 laid down
in Information Bulletin for National Eligibility-cum-Entrance Test-MDS for
admission to MDS course 2019.

2. As per Dental Council of India guidelines, the minimum percentile of marks for
eligibility for admission to postgraduate dental courses shall be 50% percentile for
General Category candidates, 45% percentile for Person with Disability (PwD) and
40% percentile for the candidates belonging to Scheduled Castes/Scheduled Tribes/
Backward Classes (BC).

3. Counseling / Admission shall be conducted by the Admission Committee

constituted by the Panjab University for this purpose

4. Candidates cannot claim a seat/admission on the basis of the NEET-MDS 2019

rank alone. Eligibility of a candidate for admission against any Post Graduate seat
will be determined by the Admission Committee, as per rules and regulations laid
down by the Panjab University & DCI from time to time. The eligibility shall also be
based on other documents as specified in the check list at page No. 14, with the
Admission Form.

5. Candidates shall attach the self attested downloaded copy of Result Card of NEET-
MDS 2019. The candidate is also required to attach self attested photocopy of the
Admit Card of NEET-MDS 2019 with ADMISSION FORM.

6. In case any candidate is found to have furnished false information or certificate, etc.
or is found to have withheld or concealed information in his/her Admission Form,
he/she shall be debarred from admission.

7. All candidates will be considered for admission in General Category. The candidates
interested to be considered under any other category also, must write the relevant
code at specified serial number 12 of the Admission Form. For Category Codes, see
‘Instructions for the Candidates’ at Sr. No. 10 of Admission Form. No candidate will
be considered for a category whose code has not been entered in the Admission
Form, even if the candidate actually belongs to that category.

8. For claims on reserved seats/categories wherever applicable, the candidates must

support their claim by attaching self attested photocopies of appropriate
certificate(s)/documents issued by competent authority as per specimen given in
Annexures to this Prospectus along with the Admission Form.

12
9. Candidate with disability, i.e., Person with Disability (PwD) shall be considered for
admission as per rules and regulations specified by Dental Council of India as
appended below:-

“5% seats of the annual sanctioned intake capacity shall be filled up by

candidates with locomotory disability of lower limbs in between 50% to 70%.

Provided that in case any seat in this 5% quota remains unfilled on

account of unavailability of candidates with locomotory disability of lower limbs
between 50% to 70% then any such unfiled seat in this 5% quota shall be filled up
by persons with locomotory disability of lower limbs between 40% to 50% before
they are included in the annual sanctioned seats for General Category candidates”.

10. INCOMPLETE ADMISSION FORM OR WITHOUT REQUISITE FEE WILL

NOT BE ENTERTAINED AND WILL BE REJECTED WITHOUT ANY
INTIMATION TO THE CANDIDATE.

13
 GENERAL INSTRUCTIONS

1. This Prospectus is subject to alteration(s) / modification(s) at any time without

notice. For updates please visit Institute website
(http://dentalsciences.puchd.ac.in) from time to time. There is no equity or
any rights that are /or deemed to be arising in favour of candidate.
2. Changes, if any, in the Schedule / Counseling etc. shall be notified only through
website of the Institute i.e. http://dentalsciences.puchd.ac.in. No candidate
shall be informed individually. Candidates are advised to browse the website
regularly for any announcements/changes and the institute shall not be
responsible for any fallout due to lack of information on the part of the
candidate.
3. Candidates must retain the copy of Prospectus & Admission Form with them.
They should carefully read the instructions, rules & regulations and comply
with all instructions therein strictly.
4. The allotment of speciality to the applicants for admission, shall be made by the
Admission Committee as per merit determined on the basis of NEET-MDS 2019
and the choice of the speciality opted by the candidate. Physical presence is
mandatory in every counseling both for General Category and Reserved
Categories candidates as per the notified dates. The candidate must bring
alongwith all the original documents.
5. The candidate should read the eligibility conditions/ criteria carefully and just
appearing in counseling does not entitle him/her for admission. The eligibility
shall be determined by the Admission Committee on the basis of documents
submitted by the candidate at the time of counseling. Those who are not eligible
as per the decision of the committee will not be considered for admission. The
candidates will appear in counseling at their own risk and responsibility.
Eligibility is also subject to medical fitness.
6. Before applying for the admission, candidate should ensure that their BDS
degree is recognized as per provisions of Dental Council of India. If it is found at
any time that BDS degree is not recognized, the candidature/Admission to MDS
course shall be cancelled.
7. Original certificates/documents shall have to be deposited by the candidate at
the time of counseling, after the seat has been allotted to the candidate. The
certificates/documents shall be returned to the candidate only on surrendering
the seat or after the completion of the course.

14
 INSTRUCTIONS FOR COUNSELING

1. Merit List for each category will be made separately based on the result of
NEET-MDS 2019. Merit list will be displayed on the Institute Notice Board and
at Institute Website on 09.04.2019 by 04.00 pm. Information regarding any
changes in the schedule or details of counseling shall be notified on the Institute
website http://dentalsciences.puchd.ac.in. No individual/separate intimation
will be provided by the Institute office for the same. Candidates are advised to
regularly browse the Institute website /to constantly follow the changes in
information, if any.
2. The allotment of speciality will be made as per the merit determined by the
NEET-MDS 2019, as per the choice of speciality by the candidate, and the
availability of seats at the time of the counseling.
3. If an eligible candidate reports late for counseling when his/her turn according
to his/her rank/merit has already been passed over, he/she will be considered
as per available seat at the time of his/her actual reporting in the counseling.
4. The candidates shall have to produce all the certificates/ degrees/
diplomas/documents in original at the time of admission/counseling as
per the check list. In case the originals are not provided at the time of
counseling, the seat shall not be allocated to the candidate and shall be
allotted to the next eligible candidate.
5. Any directions/order governing admissions to any of the course from the
Government/Hon’ble courts/Regulatory bodies will be binding on all candidates.
6. Tuition Fee structure is given as below:
MDS Fee Maintenance/ Contributio Total Fee
Users Charges n to Funds in Rs.

Ist year (2019-20) 5,34,0,10/- 1,660/- 6,000/- 5,41,670/-

IInd year (2020-21) 5,60,720/- 1,750/- 6,000/- 5,68,470/-

IIIrd Year (2021-22) 5,88,760/- 1,840/- 6,000/- 5,96,600/-

A. The fee is to be deposited on the day of counseling in the form of Demand
Draft (DD) favouring “REGISTRAR, PANJAB UNIVERSITY CHANDIGARH” payable
at Chandigarh.
B. *The fee to be charged is subject to revision by Panjab University Authorities
and amendment from time to time and the revised decision will be applicable
irrespective of that given in this prospectus.
C. Post Matric Scholarship for the SC/ST students:- The Vice Chancellor with
approval of Syndicate meeting held on 01/15/28/29 May, 2016 and as per
letter No. 2438-2537/SC/ST Cell dated 04.07.2016, “The SC/ST students of
Punjab State only”, who are eligible for Post Matric Scholarship (i.e. whose
family income is less than or equal to 2.5 lac), studying or taking admission in
Self Financing courses of Panjab University, its Regional Centres and Panjab
University Constitute Colleges, be allowed to pay only 25% of total admission
fee to the respective teaching departments of Panjab University, its Regional
Centres and Panjab University Constitute Colleges, for the academic session
year 2019-20. The students claiming this benefit are required to submit:
i. Income Certificate in Original (full detail of total family income from all
sources including the income accruing from agricultural land or any urban

15
 property/ shop/ business/ maintenance duly attested by the Competent
Authority).
ii. Copy of SC Certificate
iii. Copy of Residence Proof
iv. Copy of Bank Account Number Passbook showing IFS Code
v. Copy of Adhaar Card
vi. Copy of last exam passed certificate.
Note:- The applicability of this scholarship is subject to approval by the
Panjab University authorities for the current academic session 2019-20.

7. A monthly stipend of Rs.10,000/- shall be paid to the students for the three
years duration of the course from the date of joining.
8. In the Reserved Categories of SC/ST, the seats shall be regarded as
‘Interchangeable’. That is to say, if sufficient numbers of eligible candidates are
not available to fill up the seats reserved for Scheduled Castes the same may be
filled up from amongst the eligible candidates belonging to the Scheduled Tribes
and vice-versa.
9. In case sufficient numbers of eligible candidates, belonging to Reserved
Categories are not available, the vacant seats at the end of second counseling
shall be transferred and filled from the General Category candidates on the
basis of merit/rank obtained in NEET-MDS 2019.

16
CHECK LIST OF ORIGINAL CERTIFICATES AND TESTIMONIALS REQUIRED
FOR SCRUTINY AT THE TIME OF COUNSELLING

1. Admit Card and Result Card of NEET-MDS 2019

2. Matriculation or equivalent certificate for proof of date of birth
3. 10+2 or equivalent certificate
4. Registration certificate with State Dental Council
5. BDS Degree
6. Internship completion certificate
7. BDS Detail marks certificates – all university professional examinations
8. Character certificate from the Principal of Dental Institute last attended
(Annexure-I)
9. Certificate of Scheduled Caste/Scheduled Tribe Certificate (Annexure-II) if
applicable
10. Certificate of Backward Class (BC) Certificate (Annexure-III) if applicable
11. Certificate of Person with Disability (PwD) if applicable
12. No objection certificate from the appointing authority where presently working
(if applicable) and candidate admission will be governed by rules for in service
candidates.
13. Migration certificate for applicants from any other university other than
Panjab University (can also be submitted later after admission within 10
days)

14. Copy of Aadhaar Card

17
 Admission

1. The candidates selected for admission will have to undergo medical

examination by the constituted Medical Board on the same day or
succeeding day of their selection to the course. Only those candidates who
are found to be medically fit shall be granted admission.
2. The candidates, who do not appear before the Medical Board or are found
to be medically unfit, shall not be allowed to join the course.
3. Fee is to be paid on the day of the counseling. The candidature of the
eligible candidates, who do not deposit the prescribed fees in full, shall
stand automatically cancelled and vacancies so caused shall be offered to
the candidates next in order of merit on the same day/ subsequent
counseling. No correspondence or appeal in this connection will be
entertained by the Admission Committee.
4. Admissions shall be made strictly in accordance with eligibility criteria
and rules mentioned in this Prospectus and as per existing rules of
Panjab University and Dental Council of India. However, in all matters
which need interpretation or for which no provision exists in the
Prospectus, the decision of the Admission Committee shall be final, taken
as per rules of Panjab University Hand Book of Information 2019.
5. All admissions to MDS courses shall be provisional and subject to the
approval by Panjab University/ Dental Council of India/ any other
regulatory body.
6. All legal disputes relating to admission of students to MDS course shall
have jurisdiction in Chandigarh only.

18
 RULES FOR REFUND OF TUITION FEE

1. In the event of a candidate surrendering the seat, the fee collected from the
students shall be refunded after a deposition of Rs.1000/- as administrative
and processing fee in the form of Demand Draft(DD) favouring Registrar,
Panjab University, payable at Chandigarh provided the seat gets filled up in
the subsequent counseling. In the cases where fee has to be refunded it shall
be done only after 31st May 2019.
2. However, the fee shall not be refunded to the candidate withdrawing from the
MDS course if the seat thus left vacant is not filled up in the subsequent
counseling or if it was not possible to hold the counseling after the seat was
left for paucity of time or due to any other reasons.

19
 ANTI RAGGING

This is for the information of the students of the Panjab University campus that "RAGGING IS
COGNIZABLE OFFENCE AND IS BANNED IN ANY FORM INSIDE & OUTSIDE THE CAMPUS"

Ingredients/forms of Ragging Punishments

- Abetment to ragging; - Cancellation of admission.
- Criminal conspiracy to rag; - Suspension from attending classes and
- Unlawful assembly and rioting while ragging; academic privileges;
- Public nuisance created during ragging; - Withholding/withdrawing
- Violation of decency and morals through ragging; scholarship/fellowship and other benefits;
- Injury to body, causing hurt or grievous hurt; - Debarring from appearing in any
- Wrongful restraint; test/examination or other evaluation process;
- Wrongful confinement; - Withholding results;
- Use of criminal force; - Debarring from representing the institution in
- Assault as well as sexual offences or unnatural any regional, national or international meet,
offences; tournament, youth festival, etc.
- Extortion; - Suspension/expulsion from the hostel;
- Criminal trespass; - Cancellation of admission;
- Offences against property; - Rustication from the Institution for period
- Criminal intimidation; ranging from 1 to 4 semesters;
- Attempts to commit any or all of the above mentioned - Expulsion from the institution and consequent
offences against the victim(s); debarring from admission to any other
- Physical or psychological humiliation; institution for a specified period;
- All other offences following from the definition of - Fine ranging between Rs. 25,000/- to Rs. 1
"Ragging". Lakh;
- Rigorous imprisonment upto 3 years.
- Collective punishment: When the persons
committing or abetting the crime of ragging are
not identified, the institution shall resort to
collective punishment.
In compliance of the 3 Amendment in UGC Regulations on 29th June, 2016 to expand the definition of
rd

ragging by including the following:-

“Any act to physical or mental abuse (including bullying and exclusion) targeted at another student
(fresher or otherwise) on the ground of colour, race, religion, caste, ethnicity, gender (including
transgender), sexual orientation, appearance, nationality regional origins, linguistic identity, place of
birth, place of residence or economic background”,
Student becoming a victim of ragging should immediately inform to the concerned
Chairperson/ Warden as the case may be besides contacting on Helpline nos. given below.
Helpline Numbers for reporting the Ragging:
Dean Student Welfare 7087033309, Mail: dsw@pu.ac.in
Dean Student Welfare (W) 7087033310
Associate Dean Student Welfare 9878555311
Assistant Registrar (DSW) 2541176, 2534573, 2534570
Security Control Room Hot Line 0172-2771170, 9779737403
Security Office (24 hrs) 0172-2534897, 0172-2536164 (intercom)
Chief of University Security (Official No.) 09779824323
Anti Ragging Helpline at helpline@antiragging.in
National Anti Ragging Free Helpline No. 1800-180-5522 (24x7 Toll Free)

The Ministry of Human Resource Development vide their D.O. letter No. 16-8/2013-U.5 dated
27-12-2013 has requested that the students/parents/guardians can now file their undertaking
on anti ragging online through www.antiragging.in or www.amanmovement.org.
20
Sr. No. …………………………… Last date for receipt of Admission Form: (05.04.2019 by 4.00 pm)
Received on …………………………
Signature of Receiver..……………

PANJAB UNIVERSITY, CHANDIGARH Affix self-attested

DR. HARVANSH SINGH JUDGE INSTITUTE OF DENTAL SCIENCES & HOSPITAL recent Photograph
ADMISSION FORM (MDS) of 3.5 cm x 4.5 cm
(Academic Session 2019-20)

Panjab University Registration No. /PUPIN (if any)

1. Name of the Candidate
2. Father’s Name
3. Mother’s Name
4. Guardian’s Name
5. Date of Birth DD/MM/YYYY
6. Sex (M/F/Transgender) ____________________________________
7. Nationality
8. Address for Correspondence 9. Permanent Address

Mobile No. (Self) Mobile No. (Parents)

10. E-mail ID (Self)

E-mail ID (Parents)
11. NEET-MDS 2019-20 detail Roll No. .................................. Score.................................Rank (All India)..............................
12. Category Code (see “Instructions for the Candidates” at Sr. No. 10)
GN
13. Annual Family Income from all sources (Rs.)
14. Aadhaar Card No.

15. Blood Group ……………………………………. 16. Urban Semi-Urban Rural

17. Immunization Status :( Write Yes or No) Hepatitis B __________________ Tetanus________________
18. Hostel Required: Yes No
19. Type of vehicle to be used by the student: 4 wheeler 2 wheeler None
20. Fee Detail____________________ Draft No.___________________ Dated___________________

……………………………………………………
(Full Signature of the Candidate)

21
21
 SUMMARY OF EDUCATIONAL QUALIFICATIONS
Class Subjects Max. Marks %age Session Roll No. University/ School/
studied Marks Obtd. & Year Board College
X
XII
BDS-I

BDS-II

BDS-III

BDS-IV

DECLARATION BY THE CANDIDATE

1. I declare that I have carefully read the instructions and state that the entries made by me in this
form are correct to the best of my knowledge and nothing has been concealed. I understand that
my admission is liable to be cancelled and legal action can be taken against me if there is any
concealment/ misrepresentation in Admission Form or in the attached
certificates/undertakings/documents etc.
2. I declare that I am not doing any Post Graduate Course anywhere else.
3. I undertake to observe proper standards of Academic conduct.
4. I shall abide by the prescribed courses of readings and the modes of examinations, which may
prevail from time to time, even though these may be at variance with those of the previous
years.
5. I understand that incomplete form is liable to be rejected.
6. I shall abide by the rules and regulations as given in the Panjab University Calendars and its
revisions, Handbook of Information and Rules for Admission 2019-20.
7. I shall faithfully carry out the instructions issued by the Principal of the Institute, Faculty
members and other University authorities from time to time.
8. I hold myself responsible for prompt payment of fees and all other dues.
9. I understand that I cannot concurrently be enrolled for more than one full-time course of
studies.
10. I am fully aware that ragging is strictly prohibited/punishable under Law. If I am found guilty of
indulging in or abetting ragging, I shall be liable for expulsion from the University/Hostel and
punishment as per law.
11. I certify that I have no criminal background and have not been convicted under any criminal
offence. Further, I undertake that no F.I.R. has been registered against me or no criminal
proceedings are pending against me.
12. I undertake not to smoke and take drugs on the Campus.

22 22
13. I undertake that I will not possess/carry any lethal weapon on the University campus and if any
weapon is recovered from me then I can be rusticated from the Institute/ University and legal
action can be taken against me.
14. I shall regularly browse the Online/ Physical Notice Board of the Institute for notifications
related to attendance/instructions. Further, I understand that I shall be detained from
appearing in the examination if my attendance is below the minimum percentage of attendance
required as per the regulations of the course.

Date……………………….. ……………………………………………………
(Full Signature of the Candidate)

DECLARATION BY THE PARENT/GUARDIAN

1. I certify that my son/daughter/ward is making this application with my permission. I hold
myself responsible for his/her good conduct and behavior as a student of the University and for
payment of all his/ her fees and dues during his / her stay in the University.
2. I am aware that monthly attendance of my son/ daughter/ward will be available at the Online
Notice Board of the department and my son/daughter/ward can be detained from appearing in
the examination if his/her attendance is below the minimum percentage of attendance
required as per the regulations of the course.
3. I understand that in case of any concealment/misrepresentation by my son/daughter/ward in
Admission Form or in the attached certificates/undertakings/documents etc., his/her
admission is liable to be cancelled and legal action can be taken against him/her.

Date………………………………………………... ..…………………………………………………………..
Mobile No……………………………..………… (Full Signature of the Parent/Guardian)
E-mail ID..……………………………………….. Name: …………………………………………………..

CHECK-LIST OF DOCUMENTS ATTACHED

In addition to self-attested copies of academic certificates, the candidate should also attach self-attested
copies of the documents/certificates listed below:-
a) Admit Card and Result Card of NEET-MDS 2019-20
b) Matriculation or equivalent certificate for proof of date of birth
c) Registration certificate with State Dental Council
d) BDS Degree
e) Internship completion certificate
f) BDS Detail marks certificates – all university professional examinations
g) Character Certificate (Yes/No)
h) Certificate of Scheduled Caste/Scheduled Tribe Certificate
i) Certificate of Backward Class (BC) Certificate
j) Certificate of Person with Disability (PwD)
k) No objection certificate from the appointing authority where presently
working (if applicable)
l) Migration certificate for applicants from any other university other than
Panjab University (can also be submitted later after admission)
m) Copy of Aadhaar Card
n) Any other certificate / document______________________________________

(Full Signature of the Candidate)

23
23
 INSTRUCTIONS FOR THE CANDIDATES
1) Admission Form is of four pages. Candidates are advised to print Admission Form on both sides of the
paper.
2) All entries in the Admission Form must be made in the candidate’s own handwriting in a clear
and legible manner. INCOMPLETE FORMS SHALL BE SUMMARILY REJECTED. If any column in
the form is left unfilled or form is unsigned or any information sought is incomplete or the
copies of requisite certificate(s) is/are not annexed, the Admission Form will be straightway
rejected and no claim will be entertained later on. If any information sought is not applicable to
the candidate, the word ‘N.A.’ should be entered against that column.
3) This form, complete in all respect, must be submitted to the Institute as has been indicated in the
Admission Notice of 2019-20 on or before the last date indicated at the top of admission form.
4) All candidates will be considered for admission in General Category. The candidates interested to be
considered under any other category also, must write the relevant code at Sr. No. 12 of the Admission
Form. For Category Codes, see Sr. No. 10. No candidate will be considered for a category whose code has
not been entered in the Admission Form, even if the candidate actually belongs to that category.
5) If a candidate omits/conceals/misrepresents relevant information, his/her admission is liable to be
cancelled and legal action will be taken.
6) The format in which various certificates are to be submitted is given in the Prospectus. Only certificates
along these lines will be acceptable. The hardcopy of the same can be obtained from Institute.
7) Fees / funds and charges payable for the course by the students, shall be as prescribed by the
University from time to time.
8) Hostel seats are limited and the same will be allotted exclusively on the basis of merit as per the quota
allotted to the Institute.
9) The filling of Admission Form in no way confirms eligibility. The admission shall be provisional
throughout till the candidate’s proof of eligibility is confirmed by the University authorities.
10) For filling Sr.No.12 of Admission Form use following codes (one can fill more than one Category
Code):-
Category Code
General GN
Scheduled Castes SC
Scheduled Tribes ST
Backward Classes BC
Person with Disability PwD
Note: Addition /change in category at a later stage is not permissible under any circumstances, even
if the candidate has attached the relevant certificate along with Admission Form.

(Full Signature of the Candidate)

24
24
 ANNEXURE-I
CHARACTER CERTIFICATE
Certified that Mr./Ms. s/d/of
Sh. & Smt.
has been a bonafide student of this Institute during the period .
He/ She appeared in the BDS E x a m i n a t i o n of the
(University/Board) held in under the
Roll No. .

1. In case of any misconduct, it is suggested that brief particulars of disciplinary action

taken by Institute/Board/University during the course (session) attended, including
punishment such as expulsion, warning, fine & any disqualification for violation of rules or
persistent display of violent/aggressive behavior or display of any desire to cause harm to
any person (including himself) or committing any immoral conduct or showing criminal
tendencies if any, to be mentioned

2. General Conduct during stay in the Institution:- Good/Satisfactory/Unsatisfactory.*

3. He/She bears good moral character.
Signature
Dated:- (Principal)
(Office Seal)*
Strike out whichever is not applicable.

25
 ANNEXURE-II

SCHEDULED CASTE/ SCHEDULED TRIBE CERTIFICATE

The Caste/ Tribe Certificate should necessarily contain the following information about:

(a) Name of the person;

(b) Father's name;
(c) Permanent place of residence
(d) Name of the Caste/ Tribe
(e) Constitutional order under which the caste/ tribe has been notified
(f) signature of issuing authority along with the designation, seals and date

Authorities Empowered to issue SC/ST certificate

1. District Magistrate/ Additional District Magistrate/ Collector/Deputy

Commissioner/ Additional Deputy Commissioner/ Deputy Collector/ 1st Class
Stipendiary Magistrate/ Sub-Divisional Magistrate/ Taluka Magistrate/ Executive
Magistrate/ Extra Assistant Commissioner.
2. Chief Presidency Magistrate/ Additional Chief Presidency Magistrate/ Presidency
Magistrate.
3. Revenue Officer not below the rank of Tehsildar.
4. Sub-Divisional Officer of the area where the candidate and/or his/her family
normally resides.
5. Administrator/ Secretary to Administrator/ Development Officer (Lakshdweep
Islands).

26
 ANNEXURE-III

Certificate for Backward Class*

(persons belonging to OBC/SBC will not be considered under this category)

This is to certify that Shri / Smt / Kumari ____________________________ son / daughter of

__________________ village _____________________ District / Division ________________in the State of
Punjab belongs to ______________________ community which is recognised as a backward class
under the Government of Punjab, Department of Welfare of SCs and BCs vide notification No.
_________________________ dated _____________________ Shri / Smt / Kumari _____________________________
and / or his / her family ordinarily resides in the __________________ District / Division of the
State of Punjab.
This is also to certify that he / she does not belong to the persons / sections (creamy
Layer) mentioned in the Column 3 of the Schedule to the Government of Punjab, Department
of Welfare and SCs and BCs notification No. 1/41/93-RCI / dated 17.01.1994, as amended vide
Notification No. 1/41/93 – RCI/1597 dated 17.08.2005, Notification No. 1/41/93-RCI/209
dated 24.02.2009 and notification No. 1/41/93-RCI/609 dated 24.10.2013.

Date of Issuance Signature of Issuing Authority

Space for Photograph Designation :

Date :

Place :

Note: The term “Ordinarily” used here
Representative of People Act, 1950
Authorities Empowered to issue
Backward Class Certificate
(i) Deputy Commissioner
(ii) Additional Deputy
Commissioner
(iii) Sub-Divisional Magistrate
(iv) Executive Magistrate
(v) Tehsildar
(vi) Naib Tehsildar
(vii) Block Officer
(viii) District Revenue Officer
will have same meaning as in Section 20 of
Criteria for Admission under this
category
1. 5% seats reserved for persons belongs to
this category.
2. Candidate must belong to non-creamy
layer as defined by the latest rules of Govt.
of India.
3. *A BC certificate issued by a competent
authority in any format and on any date
shall be accepted by PU.
4. Candidate whose certificate is older
than one year from the date of issue
must submit the self declaration as per
Annexure III A.

27
 ANNEXURE-III-A

Self declaration Performa to be submitted by the person belonging to

Backward Class category at the time of Recruitment/Admission

I ______________________________S/O,D/O _____________________________________________ Resident of

____________________________ Village/Tehsil/City _______________________ District
________________________________ hereby declare that I _____________________ belong to
________________________ caste and this caste has been declared as backward class by State
Government as per letter No._________________________
dated _________________.

I hereby declare that, I do not come under Colum-3 of the Schedule to the Government of
Punjab, Department of Welfare of SCs and BCs notification No. 1/41/93-RC-1/459 dated
17.01.94 as amended vide notification No. 1/41/93-RCI/1597 dated 17.08.2005, notification
No. 1/41/93-RCI/209 dated 4.02.2009 and notification No. 1/41/93-RCI /609 dated
24.10.2013.

Declarant
Place: ________________
Date: _________________

Verification:

I hereby declare that the above submitted information is correct as per my understanding and
nothing has been concealed herein. I am well versed with the facts that I would be liable to
face any punishment prescribed by law in case my above information is found to be false and
the benefits granted to me (the applicant) will be withdrawn.

Declarant
Place: ________________
Date: _________________

28
 ANNEXURE-IV

MEDICAL EXAMINATION FORM

(The medical examination will be conducted by any Govt. Gazetted Officer/Medical Officer at
BGJIH)
(Items Nos. from 1 to 8 below to be filled in by the candidate)
Photograph
1. Name of the candidate______________________
To be attested by the
2. Father’s Name ____________________________ Physician
3. Mother’s Name ___________________________
4. Date of Birth _____________________________
5. Department (in which admission is being sought) _____________________
6. University Receipt for Medical Examination Fee
No.__________________ Date___________________ Rs. ___________
7. Roll No. (allotted by the Department):
8. History of any previous or existing illness: Yes/No (If yes, mention details)
I. Like Epilepsy(Seizures), Hypertension, Bronchitis, Bronchial Asthma, Tuberculosis,
Rheumatic Heart Disease, Diabetes etc.: Yes/No
II. History of any operation/Surgery : Yes/No
III. History of any regular medication : Yes/No
IV. History of any kind of allergy : Yes/No

____________________ __________________________
(Signature of the candidate to be (Signature of the candidate in the
attested by the Chairman) presence of examining Doctor)
________________________________
(Signature of the Chairman with seal of
the Department)
Medical Examination
General Physical Examination

(a) Pulse_________________/min. Blood Pressure______________mmHg (sitting)

(b) Vision (without glasses) Right_____ Left _____ Colour Vision_____
(c) Vision (with glasses) Right_____ Left _____
A. Systemic Examination of CNS/Chest/CVS/Abdomen/Limbs
B. Recommendation of the examining physician, if any

(Signature of the Medical Officer with seal and date)

29
 FORM OF CERTIFICATE RECOMMENDED FOR LEAVE OR EXTENSION OR
COMMUNICATION OF LEAVE AND FOR FITNESS

Signature of patient
Or thumb impression ________________________________________________

To be filled in by the applicant in the presence of the Government Medical Attendant or Medical
Practitioner. (with qualifications-MBBS or above)

Identification marks:-

a. _______________________
b. _______________________
I, Dr. _________________________________ after careful examination of the case certify hereby
that ________________________ whose signature is given above is suffering
from_______________ and I consider that a period of absence from duty of
____________________________________ with effect from ____________________ is absolutely
necessary for the restoration of his health.

I, Dr.______________________________________________ after careful examination of the case

certify hereby that __________________________ on restoration of health is now fit of join
service.

Signature of Medical attendant

Registration No._____________
(MBBS or above with Mobile #)

Note:- The nature and probable duration of the illness should also be specified. This certificate
must be accompanied by a brief resume of the case giving the nature of the illness, its symptoms,
causes and duration.

30
 FORMAT FOR MEDICAL RECORD

Name of the patient:

Age:

Sex:

Address:

Occupation:

Date of 1st visit:

Clinical note (summary) of the case:

Prov. : Diagnosis :

Investigations advised with reports:

Diagnosis after Investigation:

Advice:

Follow up

Date:

Observations:

Signature in full _________________________________

Name of Treating Physician

(MBBS or above with Mobile #)

31
Important Note:- Under this category of Physically Challenged, persons only with
Permanent Physical Disability (PPD) will be considered. Candidates with
temporary physical disability will not be eligible for applying under this
category.

COPY OF CERTIFICATE OF PERSON WITH DISABILITY (PwD) CATEGORY FOR ADMISSION

Form-I

APPLICATON FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS WITH DISABILITIES

1. Name: (Surname)__________________ (First name)_______________________

(Middle name) ______________________________

2. Father’s name:________________________ Mother’s name:___________________

3. Date of Birth: (date) __________/ (month) __________ / (year) ________________

4. Age at the time of application: __________ years

5. Sex: __________ Male/Female/Transgender

6. Address:

(a) Permanent address

_________________________________
_________________________________

(b) Current Address (i.e. for communication)

_________________________________
_________________________________

(c) Period since when residing at current address

_________________________________
_________________________________

7. Educational Status (Pl. tick as applicable)

I. Post Graduate
II. Graduate
III. Diploma
IV. Higher Secondary
V. High School
VI. Middle
VII. Primary
VIII. Non-literate

8. Occupation _____________________________________________________________
9. Identification marks (i)____________________ (ii) _______________________
10. Nature of disability:
11. Period since when disabled: From Birth/Since year __________________
12. (i) Did you ever apply for issue of a disability certificate in the past______YES/NO

(ii) If yes, details:

32
 a. Authority to whom and district in which applied
___________________________________________________
b. Result of application

13. Have you ever been issued a disability certificate in the past? If yes, please enclose a true copy.

Declaration: I hereby declare that all particulars stated above are true to the best of my
knowledge and belief, and no material information has been concealed or misstated. I further,
state that if any inaccuracy is detected in the application, I shall be liable to forfeiture of any
benefits derived and other action as per law.

_______________________________________________
(Signature or left thumb impression of
person with disability, or of his/her legal
guardian in case of persons with mental
retardation, autism, cerebral palsy and
multiple disabilities)
Date:
Place:

Encl:
1. Proof of residence (Please tick as applicable)
a. ration card,
b. voter identity card,
c. driving license,
d. bank passbook,
e. PAN card,
f. passport,
g. telephone, electricity, water and any other utility bill indicating the address of the
applicant,
h. a certificate of residence issued by a Panchayat, municipality, cantonment board, any
gazette officer, or the concerned Patwari or Head Master of a Govt. school,
i. in case of an inmate of a residential institution for persons with disabilities, destitute,
mentally ill, etc., a certificate of residence from the head of such institution.
2. Two recent passport size photographs

(For office use only)

Date:
Place: Signature of issuing authority

Stamp

33
 Form-II

DISABILITY CERTIFICATE

NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE

Recent pp size
Attested Photograph
(showing face only)
of the person with
disability
Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt./Kum.____________________________ son/wife/daughter of

Shri __________________________ Date of Birth (DD/ MM/ YY) ______ Age _____ years, male/female _____________________,
Registration No._________________________________ permanent resident of House No.______________ Ward/Village/Street
____________________ Post Office_________________, District______________________, State_________________, whose photograph
is affixed above, and am satisfied that:
(A) He/she is a case of:
 locomotor disability
(Please tick as applicable)
(B) the diagnosis in his/her case is _________________
(C) he/she has _________ % (in figure) ________________ percent (in words) permanent locomotor disability /
dwarfism / blindness in relation to his/her__________________ (part of body) as per guidelines
(............................... number and date of issue of the guidelines to be specified).
2. The applicant has submitted the following document as proof of residence:-
Nature of Document Date of Issue Details of authority issuing certificate

Signature/Thumb Signature and Seal of Authorised Signatory of

impression of the Notified Medical Authority)
person in whose
favour disability
certificate is issued.

34
 Form III

(intimation of rejection of Application for Certificate of Disability)

No. ___________________________________ Dated _______________

To
(Name and address of applicant
For Certificate of Disability)

Sub: Rejection of Application for Certificate of Disability

Sir/Madam

Please refer to your application dated _________ for issue of a Certificate of Disability for the following
disability: ___________________________________________________________________
2. Pursuant to the above application, you have been examined by the undersigned / Medical Authority on
________, and I regret to inform that, for the reasons mentioned below, it is not possible to issue a Certificate of
Disability in your favour:
(i)
(ii)
(iii)
3. in case you are aggrieved by the rejection of your application, you may represent to ______________,
requesting for review of this decision.

Yours faithfully,

(Authorized Signatory of the notified Medical Authority)

(Name and Seal)

35